The National Defense Authorization Act of 2017, signed on December 12, included a provision adding PTAs (and OTAs) as authorized providers under TRICARE. However, this change is not yet effective. The change to regulation will be implemented through the notice and comment rulemaking process. The proposed rule has not yet been released; it is expected in the fall of 2018 or spring of 2019. A 60-day comment period will follow the release of the proposed rule, after which the Department of Defense will review the comments and draft and publish the final rule. Until the rule is finalized and published, TRICARE does not consider a PTA as an authorized provider, and the rule will not be retroactive. APTA will keep members informed of the timeline for this changeover to the TRICARE system.

In an effort to establish a group of Montana Pediatric PTs, we would like to hear from you: The purpose of forming this group would be to provide more opportunities for networking, discussion and dissemination of information including continuing education that is specific to pediatric physical therapy. And with more pediatric specific MAPTA courses coming in the next year, we will have an opportunity to meet, as a more established group, in the future.

You don't need to be an APTA member to be included in this group. If you are a member, and more specifically an Academy of Pediatric Physical Therapy (APPT) member, you may already be receiving emails from Jennifer Stephens, the Montana representative for the APPT. As members of APPT, you will continue to receive news from Jennifer. This new email list, is a separate list from the APPT list. Jennifer and I are woking together to form this more comprehensive, so that all Montana pediatric PTs can be included.

If you are interested in being included in this group and would like to include your email to this list, email me at krayno67@gmail.com.

Preauthorization (PA) is no longer required for certain services rendered on and after April 1, 2018. While a PA is no longer required, services are still subject to Medical Necessity and coverage criteria for payment. Blue Cross and Blue Shield of Montana (BCBSMT) may conduct post-service claim review for the appropriateness of care.

eviCore will discontinue all PA and retrospective Utilization Management (UM) services requested by providers for the medical services identified below.

Yesterday APTA hosted a special edition of Insider Intel for our members that focused on additional details and frequently asked questions related to the Bipartisan Budget Act of 2018 signed into law on February 9. The budget deal included a permanent fix to Medicare’s hard cap on outpatient therapy services, PTA/OTA payment differential, changes to the home health payment system, funding for CHIP, and more.

A recording of yesterday’s Insider Intel webinar on the Therapy Cap has been posted to the APTA website at:

Implementation of the Physical Therapy Licensure Compact continues to move forward, as the PT Compact Commission met on November 5, 2017, in Santa Ana Pueblo, New Mexico, for its first in-person meeting. At this meeting the Commission adopted rules, bylaws, and its 2018 operating budget. The Commission's new website was also unveiled, with a demonstration of how licensees will use the site to apply for and manage compact privileges in participating states. Systems development is on track for a launch sometime in the first half of 2018.

The Commission adopted a fee of $45 for compact privileges in 2018. This is the fee an individual licensee (PT or PTA) in a participating state will pay to the Commission for a compact privilege in each state in which the licensee wishes to work. States may choose to adopt their own fees for compact privileges in addition to the Commission's fee, but state fees are yet to be determined.

A map of compact-participating states is available here. To date, 14 states have adopted the PTLC, legislation is pending in 2 states, and bill introductions are expected in several additional states in 2018.

By now, most physical therapists (PTs) have heard the news: the final 2018 Medicare Physician Fee Schedule (PFS) released in early November by the US Centers for Medicare and Medicaid Services (CMS) included some significant variations from the PFS proposed in July. Instead of finalizing CPT code values that were the same as—and occasionally larger than—current values, CMS opted to offer up a more complicated combination of cuts and increases that could affect PTs in different ways, depending on their case-mix and billing patterns.

So what should PTs do in the wake of the new PFS? Here are APTA's top 4 suggestions.

1. Know the design process for the fee schedule.
It's important to understand what led to the changes to provide context, a slight sense of relief, and a reminder of why payment needs to move toward value-based models and away from fee-for-service.

The PFS now set to debut January 1, 2018, is the CMS response to an American Medical Association (AMA) committee's recommendation on potentially "misvalued" codes associated with a wide range of professions, not just physical therapy. When the process began in early 2016, many predicted that the final outcome would be deep cuts to nearly all valuations—as much as 10% or more overall. APTA and its members fought hard to substantiate the validity of the current valuations, and even the need for increases in some areas. The end result was a significant improvement from where things were headed at the start of the process.

That's not to say it's been an entirely satisfying process from start to finish. This recent PT in Motion News story goes into more detail about the sometimes-frustrating journey from points A to B.

2. Understand what's being changed.
Just about everything that happens at CMS is complicated, and the process that led to the new CPT code valuations is no exception. Still, a working knowledge of how CPT codes are valued is helpful in understanding why the PFS contains such a mix of positives and negatives.

One important thing to understand is that code valuation is actually a stew of 3 separate elements, known as relative value units (RVUs). These are estimations of the labor, expense, and possible professional liability involved in performing any given treatment or evaluation task associated with a CPT code The 3 types of RVUs are known as "work," "practice expense" (PE), and "professional liability." The coding valuation differences between the proposed and final PFS were due to changes to the PE RVUs only.

This wasn't part of the proposed rule. While the AMA Relative Value Scale Update Committee Health Care Professions Advisory Committee did recommend changes to PE RVUs, CMS initially opted to not adopt those suggestions. When the final rule was released 3 months later, CMS—without seeking input from APTA or any other stakeholders—did an about-face and adopted the changes to PE RVUs.

So what? The answer is twofold: first, the tweaks to PE RVUs mean it's difficult to make many sweeping generalizations about how the new PFS will affect individual practices and clinics; second, it's worth noting that individual work RVUs either remained unchanged or increased.

A more detailed explanation of how the codes were affected is available in an APTA fact sheet on the 2018 PFS (listed under "APTA Summaries and Fact Sheets"). For a more complete explanation of RVUs and the differences between the 3 types, check out this APTA podcast on the CPT valuation process.

3. Get a sense of how you might be affected.
A sense of history and understanding of detail are all well and good, but the bottom line is your bottom line.

Here's the complication with the 2018 PFS: because of the wide variation in upward and downward adjustments, it's hard to make statements about how PTs in general will be affected. CMS estimates the overall impact at a 1%-2% reduction, but a lot depends on the types of patients a PT or clinic typically sees and what interventions are commonly used. Some providers could see increases.

In an effort to clear up some of the uncertainty, APTA offers a calculator than can help you see how your typical case-mix would fare in the new PFS. The calculator, offered in Microsoft Excel, allows you to enter different codes to see what changes to expect, given your Medicare service area.

4. Keep learning.
There's much more to understand about the PFS—not just in terms of the details of how the new rule will work, but in terms of APTA's work to safeguard CPT codes throughout the misvalued codes review process.

One great way to learn more about what to expect is coming up in December, when the association hosts a free webinar on Medicare changes for 2018 on December 6 from 1:00 pm to 2:00 pm ET. The webinar will be presented in a "flipped" format, meaning that when you register, you'll be provided with a prerecorded presentation to listen to in advance. That way, more of the actual session can be devoted to live interaction with the presenters. Be sure to sign up—and listen up—soon.

Another opportunity is available December 13, when APTA hosts an "Insider Intel" phone-in session that will cover many of the same topics, albeit in a pared-down 30-minute session, from 2:00 pm to 2:30 pm ET. Instructions for signing up for this session are on APTA's Insider Intel webpage.

Greetings fellow MAPTA members. I recently had the pleasure of attending the Federal Advocacy Forum March 26-28 in Washington, D.C. Over 200 members attended including 70 students to learn, get inspired and collaborate. Programming began Sunday afternoon and all day Monday. Tuesday everyone hit the hill to discuss APTA’s legislative priorities with their respective Senators and Representatives.

The APTA’s top three legislative priorities for the 115th Congress are as follows:

Medicare Access to Rehabilitation Services Act of 2017. This bill would repeal the cap on outpatient rehabilitation services, which has been in place since 1997. Currently there is an exceptions process (KX modifier/manual medical review) in place that is set to expire December 2017. Repeal of the therapy cap continues to receive strong bipartisan support. Senator Tester has been a supporter of previously introduced legislation to repeal the cap and Senator Daines has not been a supporter.

Physical Therapist Workforce and Patient Access Act of 2017. This legislation would authorize physical therapists to participate in the National Health Service Corps(NHSC) Loan Repayment Program. The NHSC addresses the health needs of more than 9.7 million underserved individuals in the U.S.

Licensed health care providers may earn up to $50,000 toward student loans in exchange for a two-year commitment at an NHSC-approved site through this program. The NHSC-approved sites are located in Health Provider Shortage Areas (HPSA). There are 112 designated HPSAs in Montana. Currently there is no rehabilitative care component within the NHSC. Senator Tester is one of the sponsors of this legislation.

Sports Medicine Licensure Clarity Act of 2017. This bill would provide certain licensure clarifications and legal protections for PTs, physicians and ATCs who practice across state lines as they travel with professional and collegiate teams or other athletes and teams sanctioned by a national governing body. Currently these health care professionals may lose their professional liability insurance coverage during travel. This bill has not yet been introduced in the Senate.

If you would like more information regarding federal advocacy issues, please feel free to contact me at kgkimgrover@gmail.com or visit the federal advocacy site at apta.org.

Interested in advocating for our profession? We are currently looking for a key contact for Senator Daines.

This course was recorded on September 22 and is now available on the APTA Learning Center, FREE to members and non-members. It is designed to introduce physical therapists to the new evaluation and reevaluation codes, and teach therapists how to select the appropriate evaluation code based on patient presentation. The new evaluation codes are split into 3 levels: low complexity evaluation, moderate complexity evaluation, and high complexity evaluation. Physical therapists will need to select the appropriate evaluation level based on 4 components: patient history, examination, patient presentation, and complexity of clinical decision making. This course includes patient scenarios specific to a variety of physical therapist practice settings, including cardiovascular and pulmonary, geriatrics, neurology, orthopedics, pediatrics, and private practice. FREE to members and non-members. Go to: http://learningcenter.apta.org/

Sponsored by: The Montana Chapter of the American Physical Therapy Association

Everyone is invited to this free, informal reception to learn how two Montana grown organizations are providing the right mobility to the right population in the right way! Join us for beverages and hors dóeuvres. We will be raising funds to supplement the cost of wheelchairs provided through a partnership between Bozeman based ROC Wheels and Helena based Families With Heart. Hear how these groups are mobilizing communities. We will talk about a farm, hippotherapy, cacao paste, building chairs, inmate involvement, AirBNB and the Casa for a Cause. Take a break, learn something new and GO Global!

Silent Auction itemsinclude textiles from Ecuador and cacao paste. Tickets are available now and at the door for a chance to win a $300 gift certificate for Chico Hot Springs. All proceeds will supplement the cost of wheelchairs for specific children in Ecuador. Everyone is welcome! You do not need to be registered for the conference to participate in this reception. Raffle tickets are available at the door or by contacting Lorena atLpettet@aol.comor 406-581-3147. You do not need to be present to win!

ROC (Reach Out and Care) Wheels is a 501(c)3 non-profit organization, which provides adaptive wheelchairs to disabled children around the globe. Since 1999 ROC has provided the gift of mobility to over 10,000 people in need from over 30 nations. We thank you for visiting the ROC Wheels website. We hope you will have the opportunity to learn about what we do and how you can be involved in changing the world, one precious life at a time. www.rocwheels.org

What Do We Do?

·Mobilize children with even the most severe disabilities in developing countries

·Empower youth of all ages to become social entrepreneurs and wheelchair builders

·Individually fit each child on a wheelchair distribution with a qualified team of volunteers

Families With Heartis dedicated to improving the lives of disabled children and families in the underdeveloped country of Ecuador. The mission is to coordinate donations from sponsor families and direct the funds to specific needs of disabled children. Funds donated through Families With Heart are used for the specific needs of the disabled child/adult and may be directed toward physical, occupational, and speech therapies; medications; or basic needs if they are currently unmet. www.familieswithheart.org